The neat statistical exercises of agencies such as the World Health Organisation (WHO) and the World Bank are clearly inadequate to capture the predicaments of Shyam Bahadur Tamang, of Rayale VDC (Village Development Committee), Kavre district, Nepal. A mechanic by trade, 48 years of age, he earns NPR 14,000 per month from his Kathmandu workshop. According to the World Bank, a person who earns one US dollar a day is above the poverty line. And according to the WHO, the average household size in rural Nepal is 5.57. Given that he spends six days of the week in Kathmandu and one day in Rayale, it is not really apparent whether Shyam Bahadur is rural or urban. Presuming him to be the former (since his family is in the village), the per capita daily income of his household should work out to USD 1.06 dollars, which, by World Bank standards, should deliver his family above the poverty line.
The only problem is that contrary to the WHO's estimate of the average family size, Shyam Bahadur's household actually numbers 20 and its total monthly cash income is NPR 17,000, which works out to a per capita daily earning of USD 0.36, leaving it well short of clearing the World Bank's poverty line. The WHO's 'complete' rural nuclear family simply does not exist in the case of this single household, which consists of two adjacent houses in which four generations live. At 48, Shyam Bahadur has a family of two parents and a paternal aunt in their mid-60s, a wife, four sons, two of whom, between them, have six children, and three other granddaughters, whose mother is the only missing member of the family.
Four months ago, and 14 years after the global Safe Motherhood Initiative commenced, Shyam Bahadur's daughter, Sheela, gave birth to a fourth daughter at her parents' house. What happened thereafter is not very certain since there are no hospital records to corroborate the household's account. According to the family, she began bleeding profusely after delivery and in due course both mother and infant passed away, within hours of each other. Since there is neither doctor nor hospital in the immediate vicinity, and since in any case the family did not have much money to spare, a 'quack', the customary low-cost community solution of long standing, was called in. He administered some medicines for a nominal fee. She died a little over 24 hours after delivery. The daughter followed a few hours later. Sheela's husband left for India soon after and has since not been heard of.
Across Nepal, women die of complications related to pregnancy. The maternal mortality rate is one of the highest in the world, and no single anecdote will be adequate to explain the extent of the continuing tragedy, which encapsulates within it not only the obvious inadequacies of government but also the failure of development agencies and financial institutions which continue to talk about the problem without bearing any of the burden.